Apparatus for the diathermic removal of growths

ABSTRACT

The present apparatus is a so called polypectome for the diathermic removal of growths, such as polyps, especially from the intestinal tract, by means of a high frequency heated wire loop which is extended out of and pulled back into a flexible tubular member. A guide bushing for the wire loop is located at the outer end of the tubular member. The guide bushing comprises guide means therein which guides the loop so that it forms an oval in its extended position and substantially an eight in its retracted position. The wire loop has a bent tip having a diameter which is smaller than the inner diameter of the guide bushing to facilitate the controlled shaping of the loop.

United States Patent Seuberth et al.

APPARATUS FOR THE DIATHERMIC REMOVAL OF GROWTHS Inventors: KurtSeuberth, Heinestrasse 27,

D-855 Forchheim/Ofr., Germany;

Peter Deyhle, Goldaverstrasse 37, CH-8006 Zurich, Switzerland Filed:June 23, 1972 Appl. No.: 265,806

Foreign Application Priority Data July 1, 1971 Germany 2132808 US. Cll28/303.14, 30/116, 128/304 Int. Cl A61b 17/38 Field of Search.....128/303.l4, 303.15, 303.16,

References Cited UNITED STATES PATENTS 10/1933 Wappler 128/303.l4

1,092,914 4/1914 Jones 128/304 3,635,222 1/1972 Robinson.. 128/130 X3,678,927 7/1972 Soichet 128/130 Primary ExaminerLucie H, LaudenslagerAttorney, Agent, or Firm-W. G. Fasse [57] ABSTRACT The present apparatusis a so called polypectome for the diathermic removal of growths, suchas polyps, especially from the intestinal tract, by means of a highfrequency heated wire loop which is extended out of and pulled back intoa flexible tubular member. A guide bushing for the wire loop is locatedat the outer end of the tubular member. The guide bushing comprisesguide means therein which guides the loop so that it forms an oval inits extended position and substantially an eight in its retractedposition. The wire loop has a bent tip having a diameter which issmaller than the inner diameter of the guide bushing to facilitate thecontrolled shaping of the loop.

9 Claims, 4 Drawing Figures APPARATUS FOR THE DIATHERMIC REMOVAL OFGROWTHS BACKGROUND OF THE INVENTION The present apparatus is a so calleddiathermy wire loop or snare for the diathermic removal of growths, morespecifically, of rank growths or so called proud flesh, tumors, polyps,and the like. The present apparatus is especially suitable for use inthe entire intestinal tract.

For viewing and examining the intestinal tract, so calledesophagus-scopes, gastro-scopes, duodeno-sopes and colonoscopes as wellas endoscopes are used. These scopes comprise substantially a longtubular light conductor which includes a conduit or channel for theinsertion of an instrument. It is known to insert through thisinstrument channel so called biopsy tongues to bring the tongues closeto a viewing window of the endoscope in order to remove tissue samplesfor test purposes.

An earlier development of our diathermy snare includes a thin steel wireforming the loop which is connected to an insulated handle by means of aflexible wire extending through a tubular member whereby a so calledBowden cable is formed. When the handle is operated the snare may beextended out of the end of the tubular member or it may be drawn intothe tubular member. The wire with the loop attached thereto is connectedto one electrode of a high frequency source delivering a frequency of,for example, 1 Mega Hz and a power of about 40 to 80 watts. The otherelectrode at the high frequency source is connected to the patientsbody.

The just described snare works satisfactorily. However, it has beenfound that there is room for improvement with regard to the control ofthe shape of the snare as it is moved into and out of the tubular memberto avoid tangling.

OBJECTS OF THE INVENTION In view of the above, it is the aim of theinvention to achieve the following objects singly or in combination:

to provide a device by means of which it is possible to remove aninternal growth such as polyps, or the like;

to perform the operation under a steady supply of protective gas inorder to avoid the ignition of gases which may be present in theintestinal tract;

to perform such removal without a laparotomy,

whereby an opening of the body will be avoided;

to provide a removal instrument which will avoid or prevent bleeding atthe place where the removal is carried out, for example by assuring aquick coagulation; and

to provide an instrument, the snare of which may be controlled as to itsshape as it is moved in and out of a tubular member whereby to avoidtangling of the wire loop or snare.

SUMMARY OF THE INVENTION According to the invention there is provided anapparatus for the diathermic removal of growths which comprises aspringy wire loop adapted for connection to a high frequency source ofpower. The loop may be pulled tight andopened by means of a connectingwire extending from actuator means through a flexible, tu bular memberto the loop whereby a so called Bowden cable is formed. The outer end ofthe loop has a bent tip of, for example, substantially semicircularshape and has a diameter smaller than the inner width of a guide bushingthrough which the loop extends. The guide bushing is provided with guidemeans shaped in such a manner that the wire loop in its extendedposition forms a oval which is twisted and its two arms are pressedtogether when the loop is pulled into said guide bushing so that theloop as it moves into the guide bushing and inside thereof assumes theshape of a somewhat longitudinal eight.

In order to avoid during the operation a possible ignition of the gaseswhich are generated in the intestinal tract, the invention furtherteaches to provide a hollow handle or actuator means of the presentapparatus with a connecting flange to which is attachable a hose or pipeconnected to a source of protective gas. The above mentioned guidebushing is provided adjacent to its outer end, that is, adjacent to theloop with lateral aperture means whereby the hollow actuator meanstogether with the flexible tubular member forms a continuous,substantially uninterrupted supply path for the protective gas from theinlet at the actuator means to the lateral aperture means in the guidebushing.

BRIEF FIGURE DESCRIPTION In order that the invention may be clearlyunderstood, it will now be described, by way of example, with referenceto the accompanying drawings, wherein:

' FIG. 1 illustrates the complete apparatus in a side view partially insection;

FIG. 2 shows a detail of the loop end of the present apparatus on anenlarged scale with the loop substantially fully extended andillustrating the guide bushing;

FIG. 3 is a view similar to that of FIG. 2 but with the loop in apartially retracted position;

FIG. 4 is also a view similar to that of FIG. 2 but with the loop fullyretracted; and

DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS The apparatus for thediathermic removal of growths comprises actuator means including ahollow body 1 which is connected to a flexible guide conduit or tubularmember 2 which may, for example be 2.5 meters long. The actuator meansfurther include an actuator rod 11 which is axially movable backandforth inside the hollow body 1, by means of a handle 3 for actuatinga wire loop 5 through a flexible connecting means or loop slider 4 whichmay be made of spring wire. The just described elements may form a socalled Bowdenor push-pull arrangement whereby the connecting wire 4 isconnected at one end thereof through the rod 11 to the operating handle3 and at the other end to the wire loop 5. The guide hose or tubularmember 2 is preferably made of elastic, synthetic, insulating material.e

The wire loop 5 is made of stainless spring steel having a diameter ofapproximately 0.2 mm and a length of about 50 to 60 mm. The wire loop 5is bent in such a manner that its front end forms a bent tip 6 having,for example, a substantially semicircular shape with a diameter smallerthan the inner width or given diameter of a bore 7' extendinglongitudinally through a guide bushing 7.

The guide bushing 7 is preferably, but not necessarily, made ofstainless steel and is securely connected to one end of the tubularmember 2. Preferably, the guide bushing is inserted into the end of thetubular member 2. The bushing 7 is provided with guide means 8 and 8'which may be in the form of chamfers as shown in FIGS. 2 to 4 at theinner and outer ends of the bushing 7. The chamfers control the shape ofthe spring steel wire loop 5, which in its extended position (FIG. 2)has the shape of a oval, so as to cause the two arms of the loop to movetoward each other when the loop is pulled into the guide bushing 7 sothat the two arms assume a predetermined shape and position, preferablyin such a manner that the loop in its retracted position (FIG. 4) insidethe bushing 7 assumes the shape of a somewhat elongated eight.

FIG. 3 shows the loop 5 drawn into the guide bushing 7 for about half ofits stroke or back and forth movement. It will be noted that the arms ofthe loop 5 glide along the chamfers 8, 8' in order to assume saidsomewhat longitudinal eight shape including an inner bight 5. Thisgliding contact will first be established with the outer end chamfer 8and then with the inner end chamfer 8'. At a particular intermediateinstant the bights of the eight may contact both chamfers 8, 8.

Incidentally, in an actual embodiment the guide bushing 7 may have, forexample, an outer diameter of 1.6 mm to snugly fit into the tubularmember 2 which may have an outer diameter of about 2.1 mm and an innerdiameter of about 1.5mm to assure said snug fit. The bore through thebushing may have a diameter of about l.O mm leaving a wall thickness forthe bushing of about 0.3 mm. The chamfers 8, 8 may be considered tobepart of the bore through the guide bushing so that the diameter of thebent tip 6 as taught by the invention, should be smaller than the widestdiameter of the chamfer.

The hollow body 1 comprises a hollow cylinder to which is attached aconnecting flange 9 which is connected through a hose 10 to a source notshown of protecting gas. Such source of protecting gas may, forinstance, contain carbon dioxide. The operating handle 3, preferably ofinsulating material, is connected to one end of said actuator or pushrod 11, the other end of which is formed as a guide piston 12 which ismovable back and forth in the hollow body 1. The push rod 11 is sealedrelative to the hollow body 1 by means of a ring seal 12' so thatasealed or closed chamber is formed in the lower end of the hollow body 1for the admission of the protective gas from the gas container throughthe hose 10, the connecting flange 9, said chamber and the tubularmember 2 all the way to the guide bushing 7, the outlet end of which isprovided with at least one lateral aperture 13 whereby the protectivegas may emerge laterally and not only forwardly in the direction of theloop 5. Thus, the entire area in which the loop is operated iscontinuously scavenged with the protective gas. This has the advantagethat ignitions are avoided which otherwise might occur because underadverse conditions small sparks may occur during the removal work. Suchsparks are as such not dangerous, however, they could cause an ignitionif the area in which the loop is being operated is filled with ignitablegases such as methane. The supply of the protective gas effectivelyeliminates any ignition danger.

The actuator rod 11 may be made of conducting material and the handlemember 3 which is made of insulating material may be provided withconnecting means 14 such as an inner thread for electrically connectinga high frequency source through the actuator 11 and through thepush-pull wire 4 to the loop 5. As a modification of the embodiment ofFIG. 1, it is possible to supply the protective gas instead of throughthe connecting flange 9 through the handle member 3. For this purpose,the hose 10 could be connected to the inner thread 14 in the handlemember 3. The push rod 11 would be hollow so that the protective gas maybe supplied through the push rod to the tubular member 2.

The apparatus according to the invention is operated as follows. Thetubular member 2 acts as a guide c0nduit. The wire loop 5 is drawn intothe bushing 7, and the apparatus is inserted into the instrument channelor conduit of an endoscope, not shown, which has been inserted into thepatient previously. The member 2 is pushed through the channel of theendoscope until the front end of the tubular member 2 exits from theinstrument channel of the endoscope. Thereafter the handle member 3 ispushed toward the hollow body 1' whereby the wire loop 5 is extended asshown in FIGS. 1 and 2. With the optical aid of the endoscope, the loop5 is placed around the growth to be removed. Thereafter, the protectivegas is supplied and the high frequency energy switched on. By pullingthe handle member 3, the loop 5 is slowly closed whereby the growth suchas a polyp is removed without any spilling of blood due to thecoagulation caused by the diathermic loop.

In view of the above, it will be appreciated that the apparatusaccording to the invention may be used for the internal removal ofgrowths such as rank growths, polyps, and the like, whereby the springywire loop is placed around the growth in the manner of a so calledelectric knife whereby the wire loop is connected at its opposite endthrough a metallic gliding member 11 with a conventional high frequencysurgical power source. As the loop is slowly closed, the growth is cutoff while bleeding is simultaneously prevented due to the coagulationcaused by the high frequency heated loop.

Thus, it is possible to avoid the so called bloody operation whichrequires the opening of the abdomen. Moreover, the patient may takenurishment immediately after the removal of the growth and may alsoleave the bed forthwith.

Although the invention has been described with reference to specificexample embodiments, it is to be understood, that it is intended tocover all modifications and equivalents within the scope of the appendedclaims.

What is claimed is:

1. In an apparatus for the diathermic removal of growths of the typecomprising a tubular member, actuator means, flexible connecting means,and a wire loop having two arms, wherein the inner end of said arms isconnected to said actuator means by said flexible connecting meansextending through said tubular member to form a Bowden connection,wherein said loop has a bent tip interconnecting said two loop arms atthe outer end thereof and wherein means are provided for supplying tosaid wire loop high frequency power, the improvement comprising a guidebushing located at an end of said tubular member remote from saidactuator means and adjacent to said wire loop, said bushing comprisingguide means for said loop, said bushing having a longitudinal boretherethrough, said bore having a given diameter, said bent tip having adiameter smaller than said given diameter, said guide means in thebushing controlling the shape of the loop as the loop is moved in andout of the bushing so that the bight formed at the outer end of the loopin its extended outer position has the shape of an oval and the size ofsaid bight is reduced as the loop is pulled into the bushing.

2. The apparatus according to claim 1, wherein said actuator meanscomprise a hollow body connected to said tubular member at its endremote from said wire loop, an actuator rod axially movable back andforth in said hollow body, said actuator rod having an inner endconnected to said flexible connecting means extending through saidtubular member, said actuator rod including an outer end extending outof said hollow body and handle means attached to said outer end of theactuator rod.

3. The apparatus according to claim 2, wherein said actuator rod has apiston attached to its inner end for sliding back and forth in saidhollow body, sealing means between said piston and said hollow body forclosing an inner chamber in said hollow body against the outer end ofthe hollow body, an inlet port in said hollow body for connecting saidinner chamber to a source of a protective gas and gas outlet aperturemeans in said bushing adjacent to said wire loop whereby anuninterrupted and substantially closed gas conduit is provided from saidinlet port through said chamber and tubular member to said aperturemeans in the bushing.

4. The apparatus according to claim 2, wherein said actuator rod has alongitudinal bore therethrough, means at said outer end of the actuatorrod for connecting said bore to a source of a protective gas, sealingmeans between said actuator rod and said hollow body to provide an innerchamber in said hollow body between the inner end of the actuator rodand the tubular member, and gas outlet aperture means in said bushingadjacent to said wire loop whereby an uninterrupted and substantiallyclosed gas conduit is provided from said bore in the actuator rodthrough said chamber and tubular member to said aperture means in saidbushing.

5. The apparatus according to claim 2, wherein said actuator rodincludes conductor means, insulating means for electrically insulatingsaid handle means from said conductor means, said flexible connectingmeans between said wire loop and said actuator rod comprising anelectrical conductor and connector means at the outer end of saidactuator rod for connecting a source of high frequency power throughsaid actuator rod and through said flexible connecting con doctor tosaid wire loop.

6. The apparatus according to claim 1, wherein said bent tip at theouter end of the wire loop has the shape of a semicircle, the diameterof which is smaller than said given inner diameter of said bushing.

7. The apparatus according to claim 1, wherein said guide means of saidbushing comprise a chamfer extending along the outer end of said bushingto surround said longitudinal bore through the bushing at the outer endthereof.

8. The apparatus according to claim 7, wherein said guide means of saidbushing comprise a further chamfer extending along the inner end of saidbushing to surround said longitudinal bore through the bushing at theinner end thereof.

9. The apparatus according to claim 1, wherein said bushing is insertedinto said tubular member with a

1. In an apparatus for the diathermic removal of growths of the typecomprising a tubular member, actuator means, flexible connecting means,and a wire loop having two arms, wherein the inner end of said arms isconnected to said actuator means by said flexible connecting meansextending through said tubular member to form a Bowden connection,wherein said loop has a bent tip interconnecting said two loop arms atthe outer end thereof and wherein means are provided for supplying tosaid wire loop high frequency power, the improvement comprising a guidebushing located at an end of said tubular member remote from saidactuator means and adjacent to said wire loop, said bushing comprisingguide means for said loop, said bushing having a longitudinal boretherethrough, said bore having a given diameter, said bent tip having adiameter smaller than said given diameter, said guide means in thebushing controlling the shape of the loop as the loop is moved in andout of the bushing so that the bight formed at the outer end of the loopin its extended outer position has the shape of an oval and the size ofsaid bight is reduced as the loop is pulled into the bushing.
 2. Theapparatus according to claim 1, wherein said actuator means comprise ahollow body connected to said tubular member at its end remote from saidwire loop, an actuator rod axially movable back and forth in said hollowbody, said actuator rod having an inner end connected to said flexibleconnecting means extending through said tubular member, said actuatorrod including an outer end extending out of said hollow body and handlemeans attached to said outer end of the actuator rod.
 3. The apparatusaccording to claim 2, wherein said actuator rod has a piston attached toits inner end for sliding back and forth in said hollow body, sealingmeans between said piston and said hollow body for closing an innerchamber in said hollow body against the outer end of the hollow body, aninlet port in said hollow body for connecting said inner chamber to asource of a protective gas and gas outlet aperture means in said bushingadjacent to said wire loop whereby an uninterrupted and substantiallyclosed gas conduit is provided from said inlet port through said chamberand tubular member to said aperture means in the bushing.
 4. Theapparatus accOrding to claim 2, wherein said actuator rod has alongitudinal bore therethrough, means at said outer end of the actuatorrod for connecting said bore to a source of a protective gas, sealingmeans between said actuator rod and said hollow body to provide an innerchamber in said hollow body between the inner end of the actuator rodand the tubular member, and gas outlet aperture means in said bushingadjacent to said wire loop whereby an uninterrupted and substantiallyclosed gas conduit is provided from said bore in the actuator rodthrough said chamber and tubular member to said aperture means in saidbushing.
 5. The apparatus according to claim 2, wherein said actuatorrod includes conductor means, insulating means for electricallyinsulating said handle means from said conductor means, said flexibleconnecting means between said wire loop and said actuator rod comprisingan electrical conductor and connector means at the outer end of saidactuator rod for connecting a source of high frequency power throughsaid actuator rod and through said flexible connecting conductor to saidwire loop.
 6. The apparatus according to claim 1, wherein said bent tipat the outer end of the wire loop has the shape of a semicircle, thediameter of which is smaller than said given inner diameter of saidbushing.
 7. The apparatus according to claim 1, wherein said guide meansof said bushing comprise a chamfer extending along the outer end of saidbushing to surround said longitudinal bore through the bushing at theouter end thereof.
 8. The apparatus according to claim 7, wherein saidguide means of said bushing comprise a further chamfer extending alongthe inner end of said bushing to surround said longitudinal bore throughthe bushing at the inner end thereof.
 9. The apparatus according toclaim 1, wherein said bushing is inserted into said tubular member witha snug fit.